Non-Pharmacological Interventions in Osteosarcopenia: A Systematic Review

Optimal resistance training parameters for improving bone mineral density in postmenopausal women: a systematic review and meta-analysis

BACKGROUND

This meta-analysis aims to explore the effects of resistance training on bone mineral density (BMD) in postmenopausal women, specifically focusing on different training intensities, durations, frequencies, and periods, across various skeletal sites lumbar spine (LS), femoral neck (FN), total hip (TH), and trochanter (Troch).

METHODS

We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies evaluating the impact of resistance training programs on BMD in postmenopausal women, covering all records up to March 2025. Two reviewers independently screened the studies, extracted data, assessed the risk of bias using the Cochrane Handbook, and performed the meta-analysis using RevMan 5.4 and Stata 18 software.

RESULTS

17 randomized controlled trials involving 690 subjects were included. The results indicate that resistance training significantly improves BMD at the LS (SMD = 0.88, 95% CI [0.21, 1.56], P = 0.01, I2 = 91%), FN (SMD = 0.89, 95% CI [0.40, 1.39], P = 0.0004, I2 = 87%) and TH (SMD = 0.30, 95% CI [0.10, 0.50], P = 0.003, I2 = 25%). However, no significant effect was observed on Troch bone density (SMD = 0.23, 95% CI [-0.01, 0.47], P = 0.06, I2 = 19%). Subgroup analysis further revealed that high-intensity training (≥ 70% 1RM) had a significant effect on the TH and FN (P < 0.05); training three times per week significantly improved bone mineral density at the LS, FN, TH, and Troch (P < 0.05); intervention durations of ≥ 48 weeks had a significant impact on FN and TH (P < 0.05); and sessions lasting 40 min had a significant effect on LS (P < 0.05).

CONCLUSION

Resistance training can beneficially influence BMD in postmenopausal women, particularly at the LS, FN, and TH. A high-intensity training regimen (≥ 70% 1RM) performed three times per week with a longer training duration may be optimal. However, significant heterogeneity among the included studies for LS and FN bone density may affect the accuracy of the pooled results, thereby limiting the generalizability of these findings. More high-quality clinical trials are needed to confirm these findings.

Assessing bone and muscle health and their association in a Mongolian population aged 40 and older: a pioneering observational study

This study in Mongolia reveals that weaker grip strength and higher sarcopenia risk are linked to greater fracture risk and lower bone density. It highlights the crucial interplay between muscle and bone health, emphasizing the need for integrated musculoskeletal assessments to prevent fractures, especially in aging populations.

BACKGROUND

Research on the relationship between bone and muscle health in low- and middle-income countries, particularly Central Asia, remains limited.

OBJECTIVES

To explore the correlation between muscle and bone health and to estimate the FRAX risk for major osteoporotic fractures (MOF) and hip fractures in the Mongolian population, stratified by age and sex.

METHODS

A cross-sectional study was conducted in Ulaanbaatar and regional Mongolia from May to August 2024. Handgrip strength, sarcopenia risk (SARC-F) and bone mineral density using peripheral DXA (BMD T-score) were assessed. Fracture risks were estimated using the FRAX model.

RESULTS

Participants (n = 857; median age, 52 years; 53.0% women) had a median grip strength of 28 kg and a median BMD T-score of - 1.9. Most (69.5%) were at low sarcopenia risk (SARC-F < 4). SARC-F was moderately correlated with FRAX scores for MOF and hip fractures (r ≈ 0.27, p < 0.001) while grip strength was negatively correlated with FRAX scores(r =  - 0.24, p < 0.001). Grip strength positively correlated with BMD T-scores (r = 0.22, p < 0.001). Fracture risks increased with age, with women showing higher rates than men. Higher sarcopenia risk (SARC-F ≥ 4) was associated with lower BMD and increased fracture risk. Lower grip strength (< 18 kg for women, < 28 kg for men) was linked to higher fracture risk and lower BMD.

CONCLUSIONS

This study highlights the interconnected nature of muscle and bone health in the Mongolian population, demonstrating that lower grip strength and higher sarcopenia risk are significantly associated with increased fracture risk and reduced bone density. These findings underscore the importance of integrated strategies for musculoskeletal health assessment and fracture prevention, particularly in aging populations.

Association of calf circumference with osteoporosis and hip fracture in middle-aged and older adults: a secondary analysis

BACKGROUND

Osteosarcopenia is a geriatric syndrome associated with an increased risk of frailty, falls, fractures, disability, and death. Calf circumference (CC) has been used as a simple and practical skeletal muscle marker to diagnose sarcopenia. This study aimed to explore the relationship of calf circumference and osteoporosis (OP) and hip fractures (HF) in middle-aged and older adults. This is important for screening OP and HF in the community and improving the quality of life of older adults.

METHODS

This study was based on the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Logistic regression analysis and restricted cubic spline were used to investigate the correlation of CC with OP and HF. The receiver operating characteristic (ROC) curve was utilized to determine the optimal cut-off value for CC. Finally, logistic regression model analysis was applied to test the predictive efficacy of CC.

RESULTS

Among 4575 individuals with a mean age of 63.0 ± 11.5 years, the OP group had higher proportions of females (P < 0.001) and non-Hispanic whites (P < 0.001). Logistic regression and RCS demonstrated that lower CC was associated with a greater risk of OP and HF in the female group (P < 0.001). ROC curves showed that CC of 33.65 cm and 33.85 cm were the best cut-off values for predicting OP and HF in middle-aged and older females. Logistic regression analyses found good predictive efficacy for cut-off values of CC in females.

CONCLUSION

In middle-aged and older women, low CC is associated with a higher risk of OP and HF. These findings have important implications for managing osteosarcopenia and associated fractures in older adults.

CLINICAL TRIAL NUMBER

Not applicable.

Osteosarcopenia predicts greater risk of functional disability than sarcopenia: a longitudinal analysis of FraDySMex cohort study

OBJECTIVES

Aging involves significant changes in body composition, marked by declines in muscle mass and bone mineral density alongside an increase in fat mass. Sarcopenia is characterized by low strength and muscle mass, and osteosarcopenia is the coexistence of sarcopenia and osteopenia/osteoporosis. Physiologically, there is a crosstalk between muscle and bone tissues mediated by several pathways. Both, sarcopenia and osteosarcopenia, have been related with adverse outcomes such as functional disability. However, there is a lack of longitudinal studies. Therefore, this study aimed to assess whether sarcopenia and osteosarcopenia phenotypes increased the risk of functional disability in a longitudinal cohort of community-dwelling adults.

DESIGN

This study constitutes a secondary longitudinal analysis of data derived from the prospective cohort FraDySMex (Frailty, Dynapenia, and Sarcopenia in Mexican adults).

SETTING AND PARTICIPANTS

FraDySMex is conducted in community-dwelling adults aged 50 years or older living in Mexico City. Data from 2014 to 2015 was considered as baseline evaluation, and the 2019 wave was the follow-up evaluation. Individuals with complete baseline and follow-up evaluations were included in the analysis.

MEASUREMENTS

Sarcopenia diagnosis adhered to the FNIH criteria, while osteopenia/osteoporosis classification followed WHO guidelines. Osteosarcopenia was defined as the concurrent presence of sarcopenia and osteopenia/osteoporosis. Functional disability was identified by the Lawton Instrumental Activities of Daily Living (IADL) Scale. Adjusted mixed-effects logistic regression models were estimated to evaluate the effect of body composition phenotype on the risk of functional disability.

RESULTS

The final sample included 320 adults with complete longitudinal data. The majority of were women (83.4%) and had 7-12 years of education (48.4%). At the baseline evaluation, 50.9% aged 50-70. The osteosarcopenia phenotype was associated with a higher risk of functional disability (OR: 2.17, p = 0.042) compared with the no osteopenia/sarcopenia group. Conversely, sarcopenia (OR: 1.50, p = 0.448) and osteopenia/osteoporosis (OR: 1.50, p = 0.185) phenotypes were not associated with functional disability.

CONCLUSIONS

Our study underscores that osteosarcopenia significantly increased the risk of functional disability, particularly in terms of Instrumental Activities of Daily Living (IADL). These results emphasize the importance of screening for sarcopenia, osteopenia/osteoporosis, and osteosarcopenia across various clinical settings. Early detection and intervention hold promise for averting functional disability and mitigating associated adverse outcomes in adults.

Association between sarcopenia and osteoporosis: the cross-sectional study from NHANES 1999-2020 and a bi-directions Mendelian randomization study

Background

Osteoporosis (OP) and sarcopenia are prevalent musculoskeletal conditions among the elderly. Nevertheless, the causal relationship between sarcopenia and OP remains a subject of controversy and uncertainty. In this study, we employed cross-sectional analysis and Mendelian randomization (MR) to investigate the intricate relationship between sarcopenia and OP.

Methods

The cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2020, which involved in 116,876 participants. It assessed the correlation between sarcopenia, osteoporosis (OP), and bone mineral density (BMD) using Chi-square tests, T-tests, and a multiple logistic regression model. Additionally, we conducted Mendelian randomization (MR) analysis to investigate the causal effects of sarcopenia-related characteristics (ALM) on OP. We employed IVW, sensitivity analysis, heterogeneity testing, and other methods for MR. The ALM data was sourced from the UK Biobank (n=450,243), while the aggregated data on OP was obtained from GWAS statistics (n=53,236).

Results

In this cross-sectional analysis, we observed that in the multivariate logistic regression model, without adjusting for any variables, OP emerged as a risk factor for sarcopenia [OR 95% CI = 1.90 (1.13-3.18), P = 0.02]. Following adjustments for gender, age, BMI, and biochemical variables, OP retained its status as a risk factor for sarcopenia [OR 95% CI = 3.54 (1.91-6.54), P < 0.001]. Moreover, after accounting for all variables, OP emerged as an independent risk factor for sarcopenia [OR 95% CI = 4.57 (1.47-14.22), P = 0.01].In the MR analysis, we uncovered that femoral neck BMD (FN BMD), lumbar spine BMD (LS BMD), and forearm bone mineral density (FA BMD) exerted a direct causal influence on ALM [FA BMD: OR 95% CI = 1.028 (1.008, 1.049), p = 0.006; FN BMD: OR (95% CI) = 1.131 (1.092, 1.170), p = 3.18E-12; LS BMD: OR (95% CI) = 1.080 (1.062, 1.098), p = 2.86E-19].

Conclusion

Our study has revealed a positive correlation between OP and the prevalence of sarcopenia. It suggests a potentially robust causal relationship between OP and sarcopenia. Notably, OP appears to be associated with a higher likelihood of losing ALM, and a significant loss of ALM may contribute to a decline in LS BMD.

Osteosarcopenia and Mortality in Older Adults Undergoing Transcatheter Aortic Valve Replacement

Importance

Osteosarcopenia is an emerging geriatric syndrome characterized by age-related deterioration in muscle and bone. Despite the established relevance of frailty and sarcopenia among older adults undergoing transcatheter aortic valve replacement (TAVR), osteosarcopenia has yet to be investigated in this setting.

Objective

To determine the association between osteosarcopenia and adverse outcomes following TAVR.

Design, Setting, and Participants

This is a post hoc analysis of the Frailty in Aortic Valve Replacement (FRAILTY-AVR) prospective multicenter cohort study and McGill extension that enrolled patients aged 70 years or older undergoing TAVR from 2012 through 2022. FRAILTY-AVR was conducted at 14 centers in Canada, the United States, and France between 2012 and 2016, and patients at the McGill University-affiliated center in Montreal, Québec, Canada, were enrolled on an ongoing basis up to 2022.

Exposure

Osteosarcopenia as measured on computed tomography (CT) scans prior to TAVR.

Main Outcomes and Measures

Clinically indicated CT scans acquired prior to TAVR were analyzed to quantify psoas muscle area (PMA) and vertebral bone density (VBD). Osteosarcopenia was defined as a combination of low PMA and low VBD according to published cutoffs. The primary outcome was 1-year all-cause mortality. Secondary outcomes were 30-day mortality, hospital length of stay, disposition, and worsening disability. Multivariable logistic regression was used to adjust for potential confounders.

Results

Of the 605 patients (271 [45%] female) in this study, 437 (72%) were octogenarian; the mean (SD) age was 82.6 (6.2) years. Mean (SD) PMA was 22.1 (4.5) cm2 in men and 15.4 (3.5) cm2 in women. Mean (SD) VBD was 104.8 (35.5) Hounsfield units (HU) in men and 98.8 (34.1) HU in women. Ninety-one patients (15%) met the criteria for osteosarcopenia and had higher rates of frailty, fractures, and malnutrition at baseline. One-year mortality was highest in patients with osteosarcopenia (29 patients [32%]) followed by those with low PMA alone (18 patients [14%]), low VBD alone (16 patients [11%]), and normal bone and muscle status (21 patients [9%]) (P < .001). Osteosarcopenia, but not low VBD or PMA alone, was independently associated with 1-year mortality (odds ratio [OR], 3.18; 95% CI, 1.54-6.57) and 1-year worsening disability (OR, 2.11; 95% CI, 1.19-3.74). The association persisted in sensitivity analyses adjusting for the Essential Frailty Toolset, Clinical Frailty Scale, and geriatric conditions such as malnutrition and disability.

Conclusions and Relevance

The findings suggest that osteosarcopenia detected using clinical CT scans could be used to identify frail patients with a 3-fold increase in 1-year mortality following TAVR. This opportunistic method for osteosarcopenia assessment could be used to improve risk prediction, support decision-making, and trigger rehabilitation interventions in older adults.

The Interconnection Between Muscle and Bone: A Common Clinical Management Pathway

Often observed with aging, the loss of skeletal muscle (sarcopenia) and bone (osteoporosis) mass, strength, and quality, is associated with reduced physical function contributing to falls and fractures. Such events can lead to a loss of independence and poorer quality of life. Physical inactivity (mechanical unloading), especially in older adults, has detrimental effects on the mass and quality of bone as well as muscle, while increases in activity (mechanical loading) have positive effects. Emerging evidence suggests that the relationship between bone and muscle is driven, at least in part, by bone-muscle crosstalk. Bone and muscle are closely linked anatomically, mechanically, and biochemically, and both have the capacity to function with paracrine and endocrine-like action. However, the exact mechanisms involved in this crosstalk remain only partially explored. Given older adults with lower bone mass are more likely to present with impaired muscle function, and vice versa, strategies capable of targeting both bone and muscle are critical. Exercise is the primary evidence-based prevention strategy capable of simultaneously improving muscle and bone health. Unfortunately, holistic treatment plans including exercise in conjunction with other allied health services to prevent or treat musculoskeletal disease remain underutilized. With a focus on sarcopenia and osteoporosis, the aim of this review is to (i) briefly describe the mechanical and biochemical interactions between bone and muscle; (ii) provide a summary of therapeutic strategies, specifically exercise, nutrition and pharmacological approaches; and (iii) highlight a holistic clinical pathway for the assessment and management of sarcopenia and osteoporosis.

Physical activity and osteosarcopenia in Korean adults aged 65 years and older: a national cross-sectional study using the KNHANES data

BACKGROUND

Osteosarcopenia is a syndrome characterized by the co-existence of osteoporosis and sarcopenia. This study aimed to examine the relationship between various types of physical activity and osteosarcopenia in community-dwelling Korean adults aged 65 years or older.

METHODS

This cross-sectional study used raw data from the fourth and fifth editions of the Korean National Health and Nutritional Survey Examination, conducted from 2008 to 2011. The researchers exclusively recruited participants aged 65 years or older for the study. These participants were categorized into four distinct groups based on their clinical factors, namely individuals without osteoporosis or sarcopenia, those with osteoporosis alone, those with sarcopenia alone, and individuals with osteosarcopenia. The International Physical Activity Short-Form was used to calculate the weekly time spent walking, moderate-intensity aerobic physical activity, and vigorous aerobic physical activity. Number of days in performing strengthening or stretching exercises were also surveyed. We used logistic regression analyses to examine the association between various physical activities and occurrence of osteosarcopenia.

RESULTS

A total of 1,342 participants (639 men and 703 women) were included in the analysis. No significant difference was observed in the amount and level of aerobic physical activity between the groups. The odds ratios below were based on participants without osteoporosis or sarcopenia as the reference category. The un-adjusted odds ratio of participants who performed stretching (male, 0.179, 95% CI 0.078-0.412; female 0.430, 95% CI 0.217-0.853) and strengthening exercises (male, 0.143, 95% CI 0.051-0.402; female, 0.044, 95% CI 0.006-0.342) at least twice per week was significantly lower in participants with osteosarcopenia compared to those without. In the adjusted analysis (adjusted by age, body mass index, house income, educational level, smoking habits, drinking status, and protein intake), only female patients in the osteosarcopenia group had a significantly lower adjusted odds ratio for performing strengthening exercise compared to female participants without osteoporosis or sarcopenia (0.062, 95% CI 0.007-0.538).

CONCLUSIONS

After adjusting for confounding factors and protein intake, women aged 65 years and older who suffered osteosarcopenia had considerably lower odds ratio of performing strengthening exercises.

Sarcopenia, osteoporosis and frailty

Muscles and bones are intricately connected tissues displaying marked co-variation during development, growth, aging, and in many diseases. While the diagnosis and treatment of osteoporosis are well established in clinical practice, sarcopenia has only been classified internationally as a disease in 2016. Both conditions are associated with an increased risk of adverse health outcomes such as fractures, dysmobility and mortality. Rather than focusing on one dimension of bone or muscle mass or weakness, the concept of musculoskeletal frailty captures the overall loss of physiological reserves in the locomotor system with age. The term osteosarcopenia in particular refers to the double jeopardy of osteoporosis and sarcopenia. Muscle-bone interactions at the biomechanical, cellular, paracrine, endocrine, neuronal or nutritional level may contribute to the pathophysiology of osteosarcopenia. The paradigm wherein muscle force controls bone strength is increasingly facing competition from a model centering on the exchange of myokines, osteokines and adipokines. The most promising results have been obtained in preclinical models where common drug targets have been identified to treat these conditions simultaneously. In this narrative review, we critically summarize the current understanding of the definitions, epidemiology, pathophysiology, and treatment of osteosarcopenia as part of an integrative approach to musculoskeletal frailty.

Low Muscle Strength, Low Bone Mineral Density, and High Body Mass Index Among Adult Special Olympics Athletes: A Cross-Sectional Examination

Adults with intellectual disabilities have increasing life expectancy but may be susceptible to early aging-related conditions. The purpose of this study was to examine associations between the presence of low muscle strength, low bone mineral density, and high body mass index with age and sex in adult Special Olympics athletes. Grip strength (n = 6,477; 40.9% female), chair stand time (n = 6,444; 40.5% female), body mass index (n = 7,824; 43.7% female), and bone mineral density (n = 3,091; 43.2% female) measurements were provided by Special Olympics International. Poor grip strength, chair stand time, bone mineral density, and body mass index were identified in 43.8%, 46.2%, 28.7%, and 50.3% of each sample, respectively. Increasing age was a risk factor for all conditions (odds ratio = 1.30-10.89; p < .05). High rates of adverse health conditions were observed in a sample of adults with intellectual disabilities. Increased risk was observed as early as the fourth decade of life.

Global trends and hotspots in research on osteoporosis rehabilitation: A bibliometric study and visualization analysis

Background

The field of rehabilitation medicine plays an essential role in the comprehensive management of osteoporosis and its consequences. The benefits of therapeutic exercise are increasingly being recognized in this area, which receives an increasing number of publications. this study was designed to comprehensively identify collaborative networks, parse and track research trends, spotlight present hotspots, and accurately predict frontiers and focus on the health topics related to osteoporosis rehabilitation.

Methods

This research adopted computer retrieval of osteoporosis rehabilitation-related research published in the Web of Science Core Collection (WoSCC) from inception to June 14, 2022. The bibliometric visualization and comparative analysis involving countries, institutions, journals, authors, references, and keywords were performed using the CiteSpace and VOSviewer software.

Results

A total of 3,268 articles were included, and the number of articles published each year has demonstrated a steady increase. The United States and the University of Melbourne were the highest productive country and institution, with 1,325 and 87 articles, respectively. The journal of osteoporosis international has published the greatest number of articles, with 221 publications, and the journal of bone and mineral research ranked first in the co-citation counts (cited by 11,792 times). The most productive and highly-cited authors were Heinonen A and Cummings S, with 35 publications and 680 citations.

Conclusions

At present, "physical activity," "weight bearing exercise," "muscle strength," "whole body vibration," "postmenopausal women," "older women," children, men are the noteworthy research hot topics. Future research that focus on the major modes and parameters of physical activity/exercise for osteoporosis (including whole body vibration, weight bearing exercises, resistance training), targeted multicomponent training regimens, rehabilitation therapy for postmenopausal women, older women, children and men, osteoporosis related-sarcopenia and fractures, and mesenchymal stem cells are becoming frontiers and focus on the health topics related to osteoporosis rehabilitation in the upcoming years, which are worthy of further exploration.

Sarcopenia and bone health: new acquisitions for a firm liaison

Osteosarcopenia (OS) is a newly defined condition represented by the simultaneous presence of osteopenia/osteoporosis and sarcopenia, the main age-related diseases. The simultaneous coexistence of the two phenotypes derives from the close connection of the main target tissues involved in their pathogenesis: bone and muscle. These two actors constitute the bone-muscle unit, which communicates through a biochemical and mechanical crosstalk which involves multiple factors. Altered pattern of molecular pathways leads to an impairment of both the functionality of the tissue itself and the communication with the complementary tissue, composing the OS pathogenesis. Recent advances in the genetics field have provided the opportunity to delve deeper into the complex biological and molecular mechanisms underlying OS. Unfortunately, there are still many gaps in our understanding of these pathways, but it has proven essential to apply strategies such as exercise and nutritional intervention to counteract OS. New therapeutic strategies that simultaneously target bone and muscle tissue are limited, but recently new targets for the development of dual-action drug therapies have been identified. This narrative review aims to provide an overview of the latest scientific evidence associated with OS, a complex disorder that will pave the way for future research aimed at understanding the bone-muscle-associated pathogenetic mechanisms.

Associations of the Alpha-Actinin Three Genotype with Bone and Muscle Mass Loss among Middle-Aged and Older Adults

Bone and muscle mass loss are known to occur simultaneously. The alpha-actinin three (ACTN3) genotype has been shown to potentially affect bone and muscle mass. In this study, we investigated the association between the ACTN3 genotype and bone and muscle mass loss in community-dwelling adults aged ≥ 60 years. This study was a cross-sectional analysis of data from 295 participants who participated in a community health checkup. The ACTN3 genotypes were classified as RR, RX, or XX types. Bone mass loss was defined as a calcaneal speed of sound T-score of <−1.32 and <−1.37, and muscle mass loss was defined as an appendicular skeletal muscle index of <7.0 kg/m2 and <5.7 kg/m2 in men and women, respectively. The percentages of XX, RX, and RR in the combined bone and muscle mass loss group were 33.8%, 30.8%, and 16.7%, respectively, with a significantly higher trend for XX. Multinomial logistic regression analysis showed that XX had an odds ratio of 3.00 (95% confidence interval 1.05−8.54) of being in the combined bone and muscle mass loss group compared to the RR group (covariates: age, sex, grip strength, and medications). The ACTN3 genotype of XX is associated with a higher rate of comorbid bone and muscle mass loss. Therefore, ACTN3 genotyping should be considered for preventing combined bone and muscle mass loss.

Progressive Resistance Training for Concomitant Increases in Muscle Strength and Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Older adults experience considerable muscle and bone loss that are closely interconnected. The efficacy of progressive resistance training programs to concurrently reverse/slow the age-related decline in muscle strength and bone mineral density (BMD) in older adults remains unclear.

OBJECTIVES

We aimed to quantify concomitant changes in lower-body muscle strength and BMD in older adults following a progressive resistance training program and to determine how these changes are influenced by mode (resistance only vs. combined resistance and weight-bearing exercises), frequency, volume, load, and program length.

METHODS

MEDLINE/PubMed and Embase databases were searched for articles published in English before 1 June, 2021. Randomized controlled trials reporting changes in leg press or knee extension one repetition maximum and femur/hip or lumbar spine BMD following progressive resistance training in men and/or women ≥ 65 years of age were included. A random-effects meta-analysis and meta-regression determined the effects of resistance training and the individual training characteristics on the percent change (∆%) in muscle strength (standardized mean difference) and BMD (mean difference). The quality of the evidence was assessed using the Cochrane risk-of-bias tool (version 2.0) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

Seven hundred and eighty studies were identified and 14 were included. Progressive resistance training increased muscle strength (∆ standardized mean difference = 1.1%; 95% confidence interval 0.73, 1.47; p ≤ 0.001) and femur/hip BMD (∆ mean difference = 2.77%; 95% confidence interval 0.44, 5.10; p = 0.02), but not BMD of the lumbar spine (∆ mean difference = 1.60%; 95% confidence interval - 1.44, 4.63; p = 0.30). The certainty for improvement was greater for muscle strength compared with BMD, evidenced by less heterogeneity (I2 = 78.1% vs 98.6%) and a higher overall quality of evidence. No training characteristic significantly affected both outcomes (p > 0.05), although concomitant increases in strength and BMD were favored by higher training frequencies, increases in strength were favored by resistance only and higher volumes, and increases in BMD were favored by combined resistance plus weight-bearing exercises, lower volumes, and higher loads.

CONCLUSIONS

Progressive resistance training programs concomitantly increase lower-limb muscle strength and femur/hip bone mineral density in older adults, with greater certainty for strength improvement. Thus, to maximize the efficacy of progressive resistance training programs to concurrently prevent muscle and bone loss in older adults, it is recommended to incorporate training characteristics more likely to improve BMD.

Is sarcopenia associated with osteoporosis? A cross-sectional study of 262 women with hip fracture

BACKGROUND

Several lines of evidence support the view that sarcopenia and osteoporosis are strictly connected. However, the capability of the updated sarcopenia definition to capture the concomitant presence of osteoporosis has been scarcely investigated.

AIM

The main aim was to assess the association between sarcopenia defined according to the revised criteria from the European Working Group on Sarcopenia in Older People (EWGSOP2) and osteoporosis in women with a hip fracture. A second aim was to investigate the thresholds for low appendicular lean mass (aLM) and handgrip strength to optimize osteoporosis detection.

DESIGN

Cross-sectional study.

SETTING

Rehabilitation hospital.

POPULATION

Women with subacute hip fracture.

METHODS

A scan by dual-energy X-ray absorptiometry (DXA) was performed to assess body composition. A Jamar dynamometer was used to measure handgrip strength. Sarcopenia was diagnosed with both handgrip strength <16 kg and aLM <15 kg. Osteoporosis was identified with femoral bone mineral density lower than 2.5 standard deviations below the mean of the young reference population.

RESULTS

We studied 262 of 290 women. Osteoporosis was found in 189 of the 262 women (72%; 95% CI: 67-78%) whereas sarcopenia in 147 (56%; 95% CI: 50-62%). After adjustment for age, time interval between fracture and DXA scan and body fat percentage the odds ratio to have osteoporosis for a sarcopenic woman was 2.30 (95% CI: 1.27-4.14; P=0.006). Receiver operating characteristic curve analyses showed that the best cut-off points to discriminate osteoporosis were 20 kg for handgrip strength and 12.5 kg for aLM. Adopting the optimized thresholds to define sarcopenia, the adjusted odds ratio to have osteoporosis for a sarcopenic woman was 3.68 (95% CI: 1.93-7.03; P<0.001).

CONCLUSIONS

This preliminary study shows a positive association between sarcopenia defined according to the EWGSOP2 criteria and osteoporosis in 262 women with hip fracture. The association may be bettered by refining the cut-off points for low aLM and handgrip strength.

CLINICAL REHABILITATION IMPACT

Sarcopenia seems to be a risk factor for osteoporosis in hip-fracture women. The issue, and the potential role of optimized thresholds should be addressed by robust longitudinal studies.

Effects of resistance training on body composition and physical function in elderly patients with osteosarcopenic obesity: a systematic review and meta-analysis

Osteosarcopenic obesity (OSO) is a complex disease commonly seen in the elderly. We found that resistance training may improve bone mineral density, skeletal muscle mass, and body fat percentage in patients with OSO. Therefore, resistance training is beneficial for elderly OSO patients and is worth being promoted.

PURPOSE

Investigate effects of resistance training on body composition and physical function in elderly osteosarcopenic obesity (OSO) patients.

METHODS

PubMed, Web of Science, Embase, Cochrane Library, Medline, SinoMed, CNKI, and Wanfang Database were searched from inception until October 13, 2021.Two independent researchers extracted the key information from each eligible study. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. The Cochrane Risk of Bias Tool was used to assess the risk of bias. Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the quality of the outcomes. Sensitivity analysis indicated the stability of the results. Statistical analysis was performed using Review Manager 5.3.

RESULTS

Four randomized controlled studies meeting the inclusion criteria were included, with 182 participants. Twelve weeks of resistance training improved bone mineral density (BMD, mean difference (MD) = 0.01 g/cm², 95% confidence interval (CI): 0.001, 0.02, P = 0.03, I² = 0%), skeletal muscle mass (SMM, MD = 1.19 kg, 95% CI: 0.50, 1.89, P = 0.0007, I² = 0%), Z score, timed chair rise test (TCR), and body fat percentage (BFP, MD =  - 1.61%, 95% CI: - 2.94, - 0.28, P = 0.02, I² = 50%) but did not significantly affect skeletal muscle mass index (SMI, MD = 0.20 kg/m², 95% CI: - 0.25, 0.64, P = 0.38, I² = 0%) or gait speed (GS).

CONCLUSIONS

Resistance training is a safe and effective intervention that can improve many parameters, including BFP, SMM, and Z score, among OSO patients and is a good option for elderly individuals to improve their physical fitness.

A pas de deux of osteoporosis and sarcopenia: osteosarcopenia

The musculoskeletal conditions osteoporosis and sarcopenia are highly prevalent in older adults. Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone, whereas sarcopenia is identified by the loss of muscle strength, function and mass. Osteoporosis represents a major health problem contributing to millions of fractures worldwide on an annual basis, whereas sarcopenia is associated with a range of adverse physical and metabolic outcomes. They both affect physical and social function, confidence and quality of life as well as contributing to high health-care costs worldwide. Osteosarcopenia is the term given when both conditions occur concomitantly and it has been suggested that interactions between these two conditions may accelerate individual disease progression as co-existence of osteoporosis and sarcopenia is associated with higher morbidity from falls, fracture, disability as well as mortality. In this review, we will outline the epidemiology, pathogenesis and clinical consequences of osteosarcopenia and discuss available management strategies.

A study of diet in older community-dwelling adults in the UK during the COVID-19 pandemic: Findings from the Southampton Longitudinal Study of Ageing (SaLSA)

Introduction

Adequate nutrition is important for health in later life. Older adults are especially vulnerable to adverse outcomes following infection by COVID-19 and have commonly spent a disproportionate time within their own homes to reduce risk of infection. There are concerns that advice to shield may have led to malnutrition as older adults may modify daily routines including usual shopping habits. The aims of this study were to report self-reported pandemic-related changes in diet and examine lifestyle and medical correlates of these changes in older UK community-dwelling adults.

Methods

We recruited 491 participants from the city of Southampton, UK. Participants completed a postal questionnaire in summer/autumn 2021, over a year after the first UK national lockdown was announced. The questionnaire ascertained demographic and lifestyle factors, in addition to number of comorbidities, nutrition risk scores, and presence of frailty. Associations between these participant characteristics in relation to self-reported changes in diet quality (lower, similar or higher when compared to before the first lockdown) were examined using ordinal logistic regression.

Results

Median (lower quartile, upper quartile) age was 79.8 (77.0, 83.7) years. Overall, 11 (4.9%) men and 25 (9.4%) women had poorer diet quality compared to before the first UK lockdown. The following participant characteristics were associated with increased risk of being in a worse category for change in diet quality after adjustment for sex: lower educational attainment (p = 0.009); higher BMI (p < 0.001); higher DETERMINE (a malnutrition assessment) score (p = 0.004); higher SARC-F score (p = 0.013); and self-reported exhaustion in the previous week on at least 3 days (p = 0.002).

Conclusions

Individuals at higher nutritional risk were identified as reporting increased risk of deterioration in diet quality during the pandemic. Further investigation of the factors leading to these changes, and an understanding of whether they are reversible will be important, especially for future pandemic management.

Exercise and Nutrition Impact on Osteoporosis and Sarcopenia-The Incidence of Osteosarcopenia: A Narrative Review

Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.

Vitamin D Deficiency in Older Patients-Problems of Sarcopenia, Drug Interactions, Management in Deficiency

Vitamin D deficiency frequently occurs in older people, especially in individuals with comorbidity and polypharmacotherapy. In this group, low vitamin D plasma concentration is related to osteoporosis, osteomalacia, sarcopenia and myalgia. Vitamin D levels in humans is an effect of the joint interaction of all vitamin D metabolic pathways. Therefore, all factors interfering with individual metabolic stages may affect 25-hydroxyvitamin D plasma concentration. The known factors affecting vitamin D metabolism interfere with cytochrome CYP3A4 activity. There is another group of factors that impairs intestinal vitamin D absorption. The phenomenon of drugs and vitamin D interactions is observed first and foremost in patients with comorbidity. This is a typical situation, where the absence of "hard evidence" is not synonymous with the possible lack of adverse effects. Osteoporosis and sarcopenia (generalized and progressive decrease of skeletal muscle mass and strength) are some of the musculoskeletal consequences of hypovitaminosis D. These consequences are related to an increased risk of adverse outcomes, including bone fractures, physical disabilities, and a lower quality of life. This can lead not only to an increased risk of falls and fractures but is also one of the main causes of frailty syndrome in the aging population. Generally, Vitamin D plasma concentration is significantly lower in subjects with osteoporosis and muscle deterioration. In some observational and uncontrolled treatment studies, vitamin D supplementation resulted in a reduction of proximal myopathy and muscle pain. The most conclusive results were found in subjects with severe vitamin D deficiency and in patients avoiding large doses of vitamin D. However, the role of vitamin D in muscle pathologies is not clear and research has provided conflicting results. This is plausibly due to the heterogeneity of the subjects, vitamin D doses and environmental factors. This report presents data on some problems with vitamin D deficiency in the elderly population and the management of vitamin D deficiency D in successful or unsuccessful aging.

Current Evidence and Possible Future Applications of Creatine Supplementation for Older Adults

Sarcopenia, defined as age-related reduction in muscle mass, strength, and physical performance, is associated with other age-related health conditions such as osteoporosis, osteosarcopenia, sarcopenic obesity, physical frailty, and cachexia. From a healthy aging perspective, lifestyle interventions that may help overcome characteristics and associated comorbidities of sarcopenia are clinically important. One possible intervention is creatine supplementation (CR). Accumulating research over the past few decades shows that CR, primarily when combined with resistance training (RT), has favourable effects on aging muscle, bone and fat mass, muscle and bone strength, and tasks of physical performance in healthy older adults. However, research is very limited regarding the efficacy of CR in older adults with sarcopenia or osteoporosis and no research exists in older adults with osteosarcopenia, sarcopenic obesity, physical frailty, or cachexia. Therefore, the purpose of this narrative review is (1) to evaluate and summarize current research involving CR, with and without RT, on properties of muscle and bone in older adults and (2) to provide a rationale and justification for future research involving CR in older adults with osteosarcopenia, sarcopenic obesity, physical frailty, or cachexia.